ICD-10 Readiness for Public Health

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1 ICD-10 Readiness for Public Health Debbie Widener Sr. Implementation & Training specialist Sonali Luniya, PhD VP, Customer Experience

2 ICD-10 Webinar: Goals ICD-10 Overview and Impacts ICD-9 vs. ICD-10 Differences ICD-10 Transition Tasks Planning and Staffing Internal Processes Remediation Work Software System Features Payer Testing Patagonia Health Product Features and Payer Testing Status Cheat Sheets Working Denials Reports and Documentation

3 ICD-10 Transition Overview ICD-10 is not optional Compliance can be expensive Provider and Administration staff engagement together is required Software vendor participation is key

4 ICD-10 Impacts Product (Technology) ICD-10 Impacts People Processes Claims and Reimbursement

5 ICD-9 CM / ICD-10 CM Differences There are two books for ICD-10 CM ICD-10 CM - Diagnosis coding system, format similar to ICD-9 CM ICD-10 PCS - Procedure classification system, ONLY for inpatient hospital settings Already being used around the world. The first being used in 1995 ICD-9 CM: Doesn t provide the necessary detail of the patients medical condition 3-5 digits First digit is alpha E, V or numeric Digits 2-5 are numeric ICD-10 CM: Incorporates much greater specificity to diagnosing patients 3-7 digits Digit 1 is always alpha Digits 2 and 3 are numeric Digits 4-7 are alpha or numeric (alpha digits are not case sensitive)

6 ICD-10 Transition Tasks Planning and staffing Review internal processes Software testing Remediation work Education Go-Live Preparation

7 Areas in your organization ICD-10 will impact

8 Planning & Staffing Identify a ICD-10 CM transition committee or project leader Identify every single place in your organization where a Diagnoses is used Communicate tasks and timelines to staff members

9 Internal Processes where Dx is used Scheduling visits or procedure visits based on Diagnosis codes Clinical workflow Patient History Update Assessments and Diagnosis Lab Orders Entry Clinical Templates/Forms Service Authorizations Encounter /Super Bill and claim creation Paper Super Bill Paper claim CMS 1500 forms Frequently Used Reports Program Based State and Federal Reports

10 Remediation Work Scheduling visits or procedure visits Cheat sheets for front office with ICD-10 CM codes Clinical workflow Cheat sheets with cross walks of commonly used diagnosis per program Check with software vendor about existing clinical data Update Lab Orders forms with ICD-10 CM codes Update Clinical Templates/Forms to have increased specificity Encounter /Super Bill and claim creation Update Paper Super Bill Update paper claim CMS 1500 forms to 02/12 version

11 Remediation Work (cont.) Frequently Used Reports Update canned reports with ICD-10 CM codes Billing needs to review any updated Clinical Coverage Policy, and Local Coverage Determinations, and payer manuals

12 Software System Features Date of service limitations Dual coding error checks in clinical notes Dual coding error checks in claim creation Coding cross walk Mapping of existing clinical data

13 Payer Testing Check with clearinghouse and software vendor Check with payer for testing cycles Volunteer to participate in payer testing CMS Medicare testing cycles open since March 2015 Check for State Medicaid and MCO testing cycles Not all states Medicaid and Medicare carriers are ready for testing.

14 Patagonia Health Product Features Clinical All services will be coded with ICD-10 CM diagnosis on 10/1/2015. System will check for dual coding in a clinical visit note Existing Patient History, Problem List in patient record will be automatically cross walked to ICD-10 CM format Services before 10/1/2015 will be coded in ICD-9 CM diagnosis Claim creation and reimbursement All claims with Date of Service after 10/1/2015 will be in ICD-10 CM System will check for dual coding during claim creation System will check for coding system based on Date of Service User can switch between ICD-9 and ICD-10 CM during claim creation GEMS mapping and look up readily available in the system

15 Patagonia Health Payer Testing Status Patagonia Health Successfully tested with State MCO systems in December 2014 Successfully tested with CMS Medicare testing in few states in May 2015 Currently testing with State Medicaid systems in June 2015 Not all states Medicaid and Medicare carriers are ready for testing.

16 Program Specific ICD-10 Cheat Sheets Child Health ICD 9 code Description ICD 10 Description V20.2 Routine child health exam ZØØ.129 Encounter for routine child health examination without abnormal findings V70.3 Med exam NEC-admin ZØ2.89 Encounter for other administrative examinations V72.2 Dental examination (dental varnishing) ZØ1.2Ø Encounter for dental examination and cleaning without abnormal findings Family Planning ICD 9 code Description ICD 10 Description V25.09 Encounter for other general counseling and advice on contraception Immunization Z3Ø.Ø9 Encounter for other general counseling and advice on contraception V25.49 Other contraceptive method Z3Ø.49 Encounter for surveillance of other contraceptives V25.41 Contraceptive pill Z3Ø.41 Encounter for surveillance of contraceptive pills V25.11 Insertion of intrauterine contraceptive device Z3Ø.43Ø Insertion of intrauterine contraceptive device V25.40 Contraceptive surveillance, unspecified Z3Ø.4Ø Encounter for surveillance of contraceptives, unspecified ICD 9 code Description ICD 10 Description Z23 replaces all ICD9 immunization diagnosis Z23 Encounter for immunization

17 Program Specific ICD-10 Cheat Sheets Tuberculosis ICD 9 code Description ICD 10 Description V74.1 Screening-pulmonary TB Z11.1 Encounter for screening for respiratory tuberculosis Nonspecific reaction to tuberculin skin test without active tuberculosis Sexually Transmitted Diseases Maternal Health (OB/GYN) R76.11 Nonspecific reaction to tuberculin skin test without active tuberculosis Ø12.8Ø Respiratory TB NEC-unspecified A15.8 Other respiratory tuberculosis ICD 9 code Description ICD 10 Description V73.89 Special screening for other specified viral diseases Z11.59 Encounter for screening for other viral diseases V74.5 Screen for venereal disease Z11.3 Encounter for screening for infections with a predominantly sexual mode of transmission Ø79.98 Chlamydial infection NOS A74.9 Chlamydial infection NOS ICD 9 code Description ICD 10 Description Z3A.00 Weeks of gestation of pregnancy not specified Z3A.01 Less than 8 weeks gestation of pregnancy Z33.1 Pregnant state, incidental Z34.00 Normal first pregnancy, unspecified trimester O Gestational diabetes mellitus, unspecified control O09.90 High risk pregnancy, unspecified, unspecified trimester

18 Program Specific ICD-10 Cheat Sheets Available cheat sheets on our web: Tuberculosis Codes Sexually Transmitted Disease STD Codes Maternal Health Codes Family Planning Codes Child Health Codes Behavioral Health Codes Generic Codes

19 Patagonia Health Working Denials Claims denied for payer not currently accepting ICD-10 CM Change ICD Indicator Dropdown to 9 Click the magnifying glass next to do a ICD-9 or ICD-10 CM code lookup

20 Patagonia Health Billing Reports Use Diagnosis Code Version All will run all diagnosis versions 9 will only show ICD-9 CM codes 0 will only show ICD-10 CM codes Billing Reports will default to diagnosis used on the claim

21 Clinical Documentation Impacts Onset of Care Anatomical site specificity Laterality Disease severity Etiology and Manifestation Complications Combination Codes Non-specific/unspecified

22 Immunizations Documentation Only one Immunization code: Z23 Type of vaccine identified by the CPT or HCPCS code Vaccine specific documentation still required Report only code Z23 for an encounter involving immunization regardless of the type or number of vaccines

23 Immunizations Documentation Influenza and Pneumonia coding simplified: Two ICD-9 codes V influenza vaccine alone V06.6 if you provide both the influenza vaccine and the pneumonia vaccine on the same date One ICD-10 CM code Z23 - regardless of how many or what types of vaccines are administered If a vaccination is not carried out, note the reason such as: Compromised condition of patient Patient refusal Parent/caregiver refusal

24 Well Child Visits Documentation Increased Specificity ICD-10 will improve the quality of data collection for well child exams, early screening, and the detection of childhood illnesses. When documenting well child exams and screenings include the following: Child s age: in days, months or years Exam type: e.g. well child exam, hearing screens, sports physicals, school physical, etc. Findings: normal vs abnormal findings, as the codes vary depending on results Coding ICD-10 Code Examples: Z Newborn check under 8 days old Z Newborn check 8 to 28 days old Z Encounter for routine child health examination with abnormal findings Z Encounter for routine child health examination without abnormal findings

25 Gynecological Documentation Documentation of gynecological conditions is relatively unchanged Vaginitis is further classified as either vaginitis or vulvitis and includes the specification of acute or sub-acute or chronic Delineation of a high risk screening mammogram is not available

26 Pregnancy / Prenatal Documentation In ICD-10 CM, antepartum encounters are classified by the trimester at the time of the encounter. Hence documentation of trimester is required. Trimester determination is calculated from first day of last menstrual period, and is documented in weeks. Code from category Z3A.-, Weeks of gestation, should be reported to identify week of pregnancy. Z3A.00 Weeks of gestation of pregnancy not specified Z3A.01 Less than 8 weeks of gestation of pregnancy Z3A.08 8 weeks of gestation of pregnancy Z3A.09 9 weeks of gestation of pregnancy ICD-10 allows for the description of pregnancy, childbirth and puerperium as distinct concepts from trimester.

27 Pregnancy / Prenatal Documentation OB codes in ICD-10 CM start with the letter O and not with the number 0 O Diseases of the nervous system complicating pregnancy, first trimester O Diseases of the nervous system complicating the pregnancy, second trimester O Spotting complicating pregnancy, first trimester O Spotting complicating pregnancy, second trimester O Spotting complicating pregnancy, third trimester O26.85 Spotting complicating pregnancy, unspecified trimester

28 Annual GYN Exam Documentation Be careful when reporting an annual GYN exam Code Z01.4- denotes an encounter for a routine GYN exam, including the following: Encounter for general GYN exam with or without cervical smear Encounter for GYN exam (general) (routine), not otherwise specified Encounter for pelvic exam (annual) (periodic) Coding Examples Z Encounter for gynecological examination (general) (routine) with abnormal findings Z Encounter for gynecological examination (general) (routine) without abnormal findings Z01.42 Encounter for cervical smear to confirm findings of recent normal smear following initial abnormal smear Physicians must document whether the exam is with or without abnormal findings, as this affects code assignment Physicians can bill an E/M code in conjunction with the appropriate ICD-10-CM code for this visit, however, only the lab can bill for the cervical smear test itself

29 Transition Tools (Education) Access to a translator. Will map ICD-9 CM code to the closest matching ICD-10 CM code. Will map ICD-10 CM code to the closest matching ICD-9 CM code. Clinical Documentation Improvement Webcasts Information about ICD-10 published by CMS

30 Additional Information Website: Phone: Additional Resources: Demo Videos Customer Videos Case Studies Download this presentation and ICD-10 CM cheat sheets at

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